U.S. Sen. Susan Collins, R-Maine, talks with Sarah McCarthy, left, a pre-doctoral fellow at the Maine Medical Research Center in Scarborough, while McCarthy analyzes sections of kidney tissue from a mouse on Friday. Staff photo by Ben McCanna

SCARBOROUGH — U.S. Sen. Susan Collins of Maine said Friday she is still firm in her opposition to Senate Republicans’ current bill to repeal and replace the Affordable Care Act, saying it would have a devastating impact on Medicaid recipients, rural hospitals and older Mainers with ACA insurance.

Collins, during an appearance at the Maine Medical Center Research Institute to tout a five-year, $20 million National Institutes of Health research grant, said that kicking millions of people off health insurance, as the Senate bill does, is “unacceptable.” The Congressional Budget Office has said that 22 million fewer Americans would have health insurance by 2026 if the Senate bill were to become law.

“I have deep concerns and am opposed to the Senate bill,” said Collins, a moderate Republican, during a question-and-answer period with reporters. “That bill would make sweeping changes to the Medicaid program. It would take out of the Medicaid program more than $700 billion. Well, you can’t take that kind of money out of a health care program and think that it’s not going to have some kind of negative impact. You don’t take a safety net program that has been operating for more than 50 years and change it in fundamental ways without having a single hearing to evaluate its impact.”

Collins said a meeting in Greenville highlighted the importance of Medicaid in rural areas of Maine, because more than half of the patients are Medicaid enrollees.

“What would happen to our rural hospitals if we put through those kind of sweeping reductions in the Medicaid program?” Collins said.

That vote would be either on the Senate bill or a straight repeal of the ACA without an immediate replacement, which some senators have advocated as an alternative approach.

But Collins and two fellow Republican senators, Lisa Murkowski of Alaska and Shelly Moore Capito of West Virginia, have already said they would vote no on a straight repeal, which would effectively kill that effort. Republicans hold a slim 52-48 majority and can only afford to lose two votes. Sen. John McCain, an Arizona Republican, was recently diagnosed with brain cancer and has been absent from the Senate. No Democrats or independents are expected to support the effort.

“I cannot support and did not support in 2015, the last time it was voted on, a bill that says, ‘Let’s just repeal the Affordable Care Act and maybe over the next two years we’ll figure out how to replace it,’ ” Collins said.

About 265,000 Mainers have Medicaid coverage, and 80,000 have ACA insurance.

Collins said that instead, Congress should turn to bipartisan reforms, and she advocated for open hearings that would bring in the voices of experts from many facets of the health care system.

“You try your best to produce a bipartisan bill,” Collins said. “That’s the way you tackle significant legislation that affects each and every American.”

In January, Collins partnered with Sen. Bill Cassidy, R-La., on a more moderate plan that would have permitted states to maintain the ACA as is. If that bill is not taken up by Congress, Collins said perhaps some elements of it could be incorporated into bipartisan fixes to the ACA.

In a separate interview with the Portland Press Herald, Collins suggested that one element of the bill, auto-enrollment into a basic health plan, could be part of the ACA and could be a way to reduce the numbers of uninsured.

“I would like to see auto-enrollments with opportunities to opt out,” Collins said.

Collins said fixing the “fiscal cliffs” in the ACA would also be an improvement. Under the ACA, enrollees are no longer eligible for subsidies if they earn more than 400 percent of the federal poverty level. Those that earn even a dollar more than 400 percent of the federal poverty level – about $50,000 for a single person – experience massive increases in premiums.

“We could fix the cliffs that exist in Obamacare, which discourage people from working more hours or accepting a pay raise. It imposes a particular burden on the self-employed, who don’t know what their income will be year to year,” Collins said, pointing to lobstermen, hairstylists, plumbers and electricians. “That makes no sense whatsoever. We should have a gradual phaseout of the subsidy.”

Collins, in the Press Herald interview, described the health care debate in Washington as “intense,” with reporters chasing her and camping out in unexpected places. One time, she felt nearly pinned against a wall after being surrounded by reporters. Another time, she thought she would go a different way to her office and try to avoid reporters by stepping outside.

“There was a whole row of cameras waiting for me. I don’t know how they knew where I was going to be and to wait outside,” Collins said.

She said she has been under pressure by the party and conservative radio talk show hosts, but the response by the public since she announced her opposition has been positive.

“In general, I have found that the people in Maine are either understanding or either agree wholeheartedly,” Collins said.

During her tour Friday, Collins visited the lab of Dr. Leif Oxburgh, who is working on growing kidney tissue in a laboratory. Eventually, people’s own cells could be used to grow kidneys in a lab that would be used to replace diseased kidneys. About 80,000 people nationwide are on kidney donation waiting lists.

Oxburgh said a lab-grown kidney is still potentially many years away from happening, if it does occur. But Oxburgh said there have been promising advances, including recently inserting lab-grown human kidney tissue into a mouse. The human kidney tissue did not die after being inserted, Oxburgh said.

Collins peppered Oxburgh and other lab workers with questions and said the research was “fascinating.”

“Think of the difference it will make for the thousands of people on waiting lists for kidney transplants,” Collins said. “It is going to save lives and that work is being done right here.”

Collins said a $2 billion increase in NIH funding approved by Congress this year helped the institute land the grant that would include a partnership between Maine Med, the University of Southern Maine and the University of Vermont. She said Congress needs to protect the NIH from cutbacks proposed by the Trump administration.

She said research that is happening in Maine and elsewhere funded by the NIH will help find treatments and cures for many chronic conditions and diseases.

“We can’t go backwards,” Collins said. “This is no time to lift our foot off the accelerator.”

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